Dr. Sandra Bloom is a psychiatrist largely responsible for the creation of the Sanctuary Model, which is both a framework for treating trauma, as well as an organizational change model that integrates evidence-based trauma interventions with the benefits of therapuetic communities. The brillance of this model is that it optimizes the safety and healing of all parties involved in social systems of care: patients and clinicians, prisoners and judges, victims and advocates, addicts and counselors. It is a model, in my opinion, that is applicable across all organizations no matter what their purpose, because it provides a roadmap for how humans should treat one another, no matter what position they may find themselves in.

Why do we need it? Because most social/healthcare service organizations are in crisis. U.S. healthcare problems were detailed in a number of publications by the Institute of Medicine, with outcomes indicating that the U.S. has the most expensive healthcare system in the world, yet ranks far down the list in terms of overall quality. But it is not just our healthcare system that is in dire need of overhauling. Our education, criminal justice, mental health, child welfare, and…yes, our addiction treatment system are all struggling to meet the needs of the populations they serve. The Santuary Model suggests that the problems are rooted in unhealthy systems, not individual people. If we understand the system, we then stand a chance of making changes within the system that ultimately translate into better outcomes for all involved.

Across the different social systems, the problems are similar: reduced funding, decreased training and education, more paperwork, more surveillance and  micromanagement, greater staff turnover, and lots of stress across all levels of organizations. These factors then translate into organizations that are chronically stressed, attempting to do more with less, always operating in a reactive/crisis mode, ultimately leading to folks being chronically hyperaroused. In this state, it is like Brian Farraher, CEO of Andrus Children’s Center has said, “Managing like your hair is on fire.”  Stress leads to a loss of basic safety and trust, a breakdown of emotional intelligence, behaviors that result in more conflict, and staff who feel disempowered. As relationships become strained, more autocratic approaches to leadership (counseling/healthcare/justice) emerge, and then folks just stop talking. In essence, organizations stop learning. The outcomes are costly for all involved.

The Santuary Model is the antidote. It acknowledges that stress, trauma…life problems, exist not only in the clients who show up for help (or are mandated for help), but also in the helpers. The served and the servers are mirrors of each other, and both require focus and attention on seven commitments:

Implementing the Sanctuary Model in organizations, and incorporating the commitments into all of our lives, means embracing our responsibility to the common good of all people, to our future, to our planet. The details of the commitments, and how best to implement them are documented on the Sanctuary Website and in Creating Sanctuary: Toward the Evolution of Sane Species.

If we ignore the warning signs so clearly right in front of us, “Human history becomes more and more a race between education and catastrophe.” HG Wells, Outline of History, 1920

Ray Materson was a straight “A” student, President of his sixth grade class, and a youthful child looking ahead to a bright future. Then a combination of risk factors both in his family and school peer group, led Ray down a dangerous path where alcohol and drugs became his best friends. Before long, his drug-seeking behavior resulted in a twenty-five year sentence for kidnapping and armed robbery. In his autobiography, Sins and Needles, co-written by his then wife Melanie, he details his journey into drug abuse, life in prison, and a discovered talent for embroidery that eventually leads to his sobriety and salvation.

I love Ray’s story because it so clearly illustrates why “create” is part of the MRC Solution to addiction. It is positive psychology at its best, optimizing life, providing meaning and hope, and unlocking innate talent that is more powerful than addiction.

Recently, Ray and I spoke on the phone. I appreciated his candor and honesty about his life, and his reponses to some of the questions that remained for me after reading the book. Without giving too much away, Ray’s tenancity for his art and willingness to allow the correctional system to do its job,  eventually results in a second chance at life. His website documents many of his achievements and has a great video presentation showcasing his work, as well as a personal interview. He summed-up what helped him most deal with addiction by saying: 1) my art work, 2) personal affirmations specific to self-esteem, 3) support from other people, and 4) a higher power.

Successfully dealing with addiction is not for the faint at heart. It is a challenging road, requiring significant effort at many junctures in life. Has emboridery solved all of Ray’s troubles?…of course not. But in talking with him, it is clear that through his art he has learned to speak his truth. He has learned to speak of his pains and joys, his successes and failures, and his fears and hopes for the future. Godspeed Ray.

This past week I had a few minutes to spare in Washington DC, so I dropped by the National Geographic Society headquarters and discovered a project that has significant relevance to successfully solving the problem of addiction. Writer and photographer Dan Buettner embarked on a journey around the globe in search of communities that optimized lifestyle for longevity and happiness, places he calls blue zones.  He boiled down his research for the book Blue Zones into principles for living a long and prosperous life. Here is a great summary of the book he did for TED:

For those who struggle with addiction, the keys outlined in the book (and the speech above) provide a road map for translating the MRC solution into reality. Let’s look at how they line up:

Manage
Successfully dealing with addiction requires identifying those things in your life that are chronic issues, and then developing strategies that appropriately keep these things in-check. When we expect to permanently solve a chronic problem we set ourselves up for failure because there is no cure or end to these issues, they require ongoing attention. Addiction, diet, chronic medical issues, time and exercise are all things we must learn to successfully manage. In Blue Zones, the keys that line up with manage include: 

• Learn to move naturally. Those who live to be 100 rarely engage in rigorous exercise. Instead, they incorporate  walking, gardening, yoga and other less body-stressful movements into their daily routine. Developing a healthy lifestyle free from addiction necessitates learning to move in the world in a new way, in a natural, physically and emotionally pain-free way.
• Slow down. Our culture perpetuates addictive behavior by encouraging lifestyles where multi-tasking, reliance on technology, and instant gratification become packaged in a speedaholic existence. Not so for those who live in blue zones. An important aspect of successful long-term management of addiction is learning to slow down, become conscious of how you spend your time, and align it with what is most important in your life.
• Eat and drink wisely. Food and drink are common objects of addiction, and although abstinence from alcohol is possible, we cannot stop our relationship with food. The same goes for those who struggle with sexual addiction. It is not possible to remain abstinent from sex, we are sexual beings by nature and healing requires finding healthy ways to express our sexuality. The key is moderation, balance, and of course, eating more fruits and vegetables. Red wine has also been shown to increase longevity, but if it creates more problems than benefits (e.g., abuse, relapse) it should not be on your list.

Resolve
There are some life problems that we should not manage, but solve, permanently. Homelessness, debt, acute pain, many developmental constrictions/deficits, legal problems, and suicide ideation. None of these things are healthy to manage over a long period of time, and our work should focus on resolution. Two significant problems most addicts need to resolve are lonliness and isolation. The key that lines-up with resolve is:

• Be Connected to Others. Those who live the longest put family and loved ones first. They belong to communities that nurture and protect each other. Many share their spiritual faith in community, and hang out with people that have healthy habits, both physical and emotional. I have written a lot about how the essence of solving the problem of addiction is disconnecting from object-relationships and learning to engage in healthy, intimate connections with people. But to do this very often requires resolving barriers to human relationships. These barriers include unresolved trauma that lead to isolation, developmental stuck points, and debilitating shame and grief. This work is not easy, but necessary for relationships to blossom.  

Create
Many who struggle with addiction spend all their time on the pathological side of the equation. Treatments, interventions, fixes, cures, treatments….all intended to reduce or stop addictive behavior. This stuff is important, but at the same time it needs to be integrated with actions that optimize life.  Sometimes taking a break from intervening on addictive behavior and directing energy to what we want out of life can actually produce the outcomes we seek. Those who live in blue zones:

• Have a clear purpose. They call it “ikigai” – the reason for which you wake-up in the morning. If your ikigai is that you don’t want to drink, smoke,  or act-out today, well…this is not a very compelling reason to get out of bed, it just gets you to focus on what you don’t want! The key is redirecting your life energy towards creating what you do want.

For additional information on blue zones, checkout the author’s website: bluezones and the book.

It was just like any other day, arriving home from high school, popping into the kitchen for a snack. The phone rang and I can still hear the words of my best friend’s older brother as if it was yesterday … ”John, you should sit down. Last night Doug took his life.” Let me be clear, Doug was not an addict. He was an exercise fiend and taught me the ways of the gym, inspiring me to never stop lifting weights. His death was a tragedy, the end result of an intractable seasonal affective disorder that left him incapacitated during the winter months. I was asked to be a pallbearer at the funeral, and remember very little from the experience. It was emotionally overwhelming…traumatic to say the least.

Only recently have I began to understand how significant his death has been in my life, and how early trauma has played a role in my experiencing numerous deaths as traumatic. A few years ago very close friends all died tragically in a plane crash in Alaska, and a couple of years ago a cousin took his own life. Collectively, these events have made it very difficult for me to be completely conscious, emotionally open, and accepting of death when it occurs. For many who struggle with addiction, death is one of those topics that goes straight to the core. In fact, death goes deep with all of us.

It is challenging to fully live in the present if we have not faced on some level our own mortality. More and more I find myself staring into the mirror wondering “who is that guy“…wondering where the youthful look, hair, and energy have gone. As I watch my son with boundless energy want to stay up all night building legos, I remember the late nighters in college that came effortlessly. Now, I can’t wait to crawl into bed early and let my body rest. Perhaps it has something to do with the increasing pace of life, but I know also that before long (if it has not already happened), I will be on the downside of the curve. Life is finite, my own death inevitable. I also know that as I grow older I will increasingly lose those I love most. But the gift of life is that we can use it to prepare for death – our own and others. It should not be an overwhelming, paralyzing experience. How am I working the issue of death?

• Trauma resolution: I am identifying traumatic life events, particularly those that have been closely linked to death, and then slowly, safely, allowing myself to connect the memories to the emotional experiences. Trauma work ultimately is about integration: head, heart, body, mind, spirit, feelings, thoughts, behaviors - all aligned.
• Meditation: I find meditating on death a great way to peel the onion, remove the layers of fear, and connect with a core part of myself that does not fear dying and realizes that we ultimately die as we live.
• Meaning/Purpose: As I get older I realize more and more the importance of identifying what gives my life meaning, and then aligning my actions with that purpose. Family first, everything else second.
• Grief/Sadness:  I feel…experience…stay with…breath…
• Unfinished Business: I know there will always be unfinished business, that is part of life. So for me this really is about the present, and how I am spending my time. It’s not so much how many “to do’s” I was able to check off the list, but more about whether I had the right things on the list to begin with.
• Visit those who are gone: No, I don’t participate in seances, but visting the gravesites of those I have known is a concrete way to embrace my own mortality.
• Faith: It all comes down to faith, the forcefield of life. Death is the great mystery, and what’s on the otherside is reflected in my relationship to that which is beyond myself. The infinite.